Best Procedure for Firming Neck and Chin?

Firming the neck and chin does not lend itself to a "one-size-fits-all” approach. The appropriate surgical treatment plan will vary from patient to depending on whether the issues are excess skin, excess fat, platysma muscle separation, or all three. The best course of action will also be dictated by exactly where the sagging and fat accumulation is. It may take a Face Lift and/or Neck Lift to tighten the skin, and restore youthful contour to the jaw line, chin and neck. The procedure used will include tightening the platysma muscle to eliminate the appearance of cords. After recovery, what you can expect is a neck that appears longer and considerably more graceful and smooth.

There are also non-surgical approaches to firming the neck and chin, Ultherapy being one of the most effective. It is a one-time, ultrasound treatment that results in a very natural-looking lifting and tightening of the neck and chin. However, because the ultrasound energy triggers increased collagen production, it may take 3 to 4 months to see maximum results. Additionally, if the condition of the neck and chin are very severe, this protocol will not deliver the dramatic correction of a surgical approach.

I advise you to schedule consultations with two or three board certified plastic surgeons and see what treatment plan they recommend. Then entrust yourself to the surgeon with the most experience and best track record when addressing the lower face, chin and neck.

Neck Lift (Cervicoplasty / Platysmaplasty): restoring elegance to the face

If a person’s neck does not appear youthful, the face – no matter how limited the aging changes are – will often not be perceived as youthful either, unless the aging neck is concealed.

Even in the absence of other signs of facial aging, a poorly-defined or sagging neck can add years to a patients overall facial appearance. When performed expertly and with great attention to detail, a necklift surgery can dramatically restore a natural and youthful neck profile, with no outward evidence that surgery has been performed. The adjective that immediately comes to mind when I review ‘before and after’ images of my necklift patients is elegant – for restoring a youthful neck contour truly makes the patient appear not just younger but also refined and elegant.

A very wise and very talented surgical mentor of mine put it very succinctly: in facial rejuvenation surgery, “Get the neck right.” A youthful and well-contoured neck, with no distortions of the surrounding tissues and anatomic structures, is the foundation of a beautiful and youthful-appearing face.

Though it is not technically part of the face, a neck with loose, sagging skin can age the face dramatically. A neck lift is a standard part of most facelift surgeries, as the neck skin is mobilized in continuity with the lower face.

Immediately under the skin of the neck is the platysma muscle, which you can easily see in a mirror when you clench your teeth and tighten your jaw. In youth, this paired muscle meets in the midline below the chin. With age, the right and left sides of the platysma often separate, producing vertical 'cords' in the anterior neck. The platysma can be divided anteriorly and tightened during neck lift cosmetic surgery to permanently eliminate these 'cords' and improve the neck contour. One tightened in the midline below the chin, lateral traction on the platysma then creates a 'sling' which elevates the soft tissues below the jawline.

Cervical / submandibular liposuction

Some individuals have 'sagging' necks primarily due to fat accumulation below the jawbone (mandible). In some cases, liposuction alone can significantly improve the neck appearance. Liposuction is also frequently combined with surgical neck rejuvenation, and in selected cases some direct excision of fat (through a hidden incision below the chin) is performed. The reduction of fat in the area below the jawline and in the anterior neck almost always makes the neck appear longer, and makes the patient's profile appear more elegant or refined.

Suture suspension neck lift

In cosmetic surgery patients that do not have a sharp transition in profile between the submental area (area below the jawline) and the anterior neck, and in patients who simply want that transition enhanced, I add a 'suture suspension necklift'. A permanent suture is passed subcutaneously across the anterior neck, at the level corresponding to depth of the angle between the submental area and anterior neck, and is then anchored to the deep soft tissues behind each earlobe. This suspension cosmetic surgery procedure can dramatically enhance the definition between the jawline and anterior neck, producing a more elegant profile.

The neck is without question the primary 'facelift' aesthetic area where subtractive (excisional) and tightening procedures restore a truly youthful contour. Once again, take a look at the fashion magazines: essentially every neck you'll see demonstrates something close to a right angle between the neck and jaw. When it comes to the neck, and only in the neck, flat is good.

Every case must be individualized.
If your neck is your only concern, you may consider a neck lift.  The idea or the main goal in these surgeries is to obtain the most refreshed and most natural results.

Technology has brought some very useful and elegant solutions for firming the neck:  the main technology options we use in our facility include Ultherapy, ThermiTight and laser assisted neck contouring (AccuLift  and Precision Treatment).

Ultherapy is a completely non-invasive method of skin tightening that utilizes high frequency high intensity sound energy to heat tissues below the skin level.  The treatment causes breakdown of collagen at hundreds of points and stimulates a healing response that leads to tissue contraction and skin tightening.  Ultherapy is best for patients with early mild neck skin laxity and minimal fullness from fatty tissue accumulation.  There is no downtime after the Ultherapy treatment.  Results are not immediate.  Some early firming may be noticed within one to two months after treatment - maximum results are typically apparent after four to six months. 

ThermiTight is a minimally invasive procedure from ThermiAesthetics that uses "Injectable RF (radio frequency)" energy to tighten the collagen bands of the fibrous septal network beneath the skin.  After the tissue is numbed with local anesthetic a slender probe with a metal tip is inserted beneath the skin and the RF energy is delivered to the tissue.  The system uses an internal temperature monitor to ensure that the desired therapeutic treatment temperature is reached but not exceeded.   During the treatment an advanced thermal camera (FLIR, forward looking infra red) is used as an additional safety measure to ensure that the skin is not overheated.  Sight swelling may be evident for a few days or longer but most patients are able to resume most activities (except strenuous exercise) the next day.  ThermiTight is best for patients with mild to moderate neck skin laxity with little or only mild fullness from fatty tissue accumulation.  Results are not immediate.  As the fibrous septal network bands contract the skin tightens.  Some early firming may be evident within four to six weeks after treatment - maximum results are typically apparent six to twelve months after treatment.   

Laser assisted neck contouring is a minimally invasive procedure that uses a laser to target collagen, fat and water under the skin.  After the tissue is numbed with local anesthetic the laser fiber is inserted beneath the skin and the laser energy is delivered to the tissue.  The laser energy is absorbed by collagen, fat and water.  Collagen tightens and fat cells break apart and liquefy as the laser energy is absorbed.  The water that is injected with the local anesthetic serves as a thermal reservoir (heat sink) to contain the energy and heat and prevent skin injury.  After the laser energy is delivered the fatty tissue is removed with a small liposuction cannula.  Some patients may need a small incision under the chin to allow the surgeon to surgically tighten the platysma muscle.  A neck wrap or compression dressing is placed immediately after the procedure.  Significant improvement should be evident immediately for most patients but swelling can linger for several weeks or longer such that maximum improvement may not be apparent for a while.  

A facelift is very effective with firming up the neck. Consider improving the chin area with a chin implant at the same time.

The "best procedure" for firming the neck and chin may vary from patient to patient. When evaluating the jawline and neck, aging changes to the skin, soft tissue, and the underlying muscle are assessed, as well as the underlying skeletal anatomy. Family genetics and environmental exposures, such as sun and tobacco, influence the way we age, and we all look different as we grow older. Some patients have excess skin, others excess fat, and others muscle laxity with loss of the angle under the chin. Only through a precise assessment of anatomy can a plan be formed. Some patients benefit from simple liposuction or use of Precision TX, a skin tightening laser. Others may require a neck lift, mini facelift, or more formal lower facelift. Only by meeting with a board-certified plastic surgeon can the ideal procedure be determined.

The neck and chin area can often times show the appearance of age with loose skin, wrinkles, or an accumulation of fat. For best results, each concern should be addressed separately and a plan devised. Often liposuction of the neck or skin tightening is a reasonable combination of procedures to improve the appearance of a loose or a fatty lower neck. Depending on the patient’s expectations, liposuction will not correct sagging or wrinkled skin. If these are the patient concerns, then a lower facelift tightening procedure may need to be considered. If there is additional fullness under the chin and within the neck, then liposuction can be utilized in conjunction with a facelift. I recommend consulting with a board certified facial plastic surgeon to access an accurate diagnosis of your particular condition. All the best—Dr. Cohen

There are three components in the neck that must be addressed for a comprehensive neck rejuvenation. These components are excess skin, fat above and below the muscle, and the  platysma muscle itself. The anterior platysmal bands are tightened with sutures placed in the  platysma muscle. Fatty  deposits are  removed above and below the platysma muscle, and excess skin is tightened through incisions behind the ears. A lower face/neck lift is the most appropriate operation since a neck lift alone will not address the skin laxity. For many examples of neck lifts and faces/neck lifts, please see the link below

This is probably not the answer you want to hear but, in my opinion, the best option for firming up the neck and chin is a facelift. That having been said, it is not a popular option and many individuals seek non-surgical treatments such as Thermage. The problem with many of these treatments is that they may be capapble of tightening the skin. However, they may deliver a 1-2 on a scale of 10 when what you need is a 7-8. IF you select a less agressive approach, be prepared to accept a less agressive result.

Many patients come to us asking for their neck to be improved when, in fact, it is actually the face that needs improvement and that procedure also improves the neck. However, some patients truly have very little sagging skin in the face but have some excess fat in the neck along with mildly sagging skin in this region.

The "neck" really refers to jawline down to the clavicle. If the excess skin is near the jaw line (jowls), then the only real treatment is a facelift. If the excess skin an fat is below that, then it is possible to use alternative treatments. One of these is ultrasonic-assisted liposuction. This can remove some of the excess fat in the neck, and at the same time cause some tightening of the skin.

The best way to determine your options is truly with a consultation. Good luck.